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215 ILCS 5/356z.29

    (215 ILCS 5/356z.29)
    (Text of Section from P.A. 100-1026)
    Sec. 356z.29. Coverage for hearing aids for individuals under the age of 18.
    (a) As used in this Section:
    "Hearing care professional" means a person who is a licensed hearing instrument dispenser, licensed audiologist, or licensed physician.
    "Hearing instrument" or "hearing aid" means any wearable non-disposable, non-experimental instrument or device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories for the instrument or device, including an ear mold but excluding batteries and cords.
    (b) An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 100th General Assembly must provide coverage for medically necessary hearing instruments and related services for all individuals under the age of 18 when a hearing care professional prescribes a hearing instrument to augment communication.
    (c) An insurer shall provide coverage, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, subject to the following restrictions:
        (1) one hearing instrument shall be covered for each
    
ear every 36 months;
        (2) related services, such as audiological exams and
    
selection, fitting, and adjustment of ear molds to maintain optimal fit shall be covered when deemed medically necessary by a hearing care professional; and
        (3) hearing instrument repairs may be covered when
    
deemed medically necessary.
    (d) If, at any time before or after the effective date of this amendatory Act of the 100th General Assembly, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for medically necessary hearing instruments and related services for individuals under the age of 18, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for medically necessary hearing instruments and related services for individuals under the age of 18.
(Source: P.A. 100-1026, eff. 8-22-18.)
 
    (Text of Section from P.A. 100-1057)
    Sec. 356z.29. Stage 4 advanced, metastatic cancer.
    (a) As used in this Section, "stage 4 advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body.
    (b) No individual or group policy of accident and health insurance amended, issued, delivered, or renewed in this State after the effective date of this amendatory Act of the 100th General Assembly that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment of stage 4 advanced, metastatic cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or prove a history of failure of the drug as long as the use of the drug is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer and is supported by peer-reviewed medical literature.
    (c) If, at any time before or after the effective date of this amendatory Act of the 100th General Assembly, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of the prohibition of coverage restrictions or exclusions contained in subsection (b) of this Section for the treatment of stage 4 advanced, metastatic cancer, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the prohibition of coverage restrictions or exclusions contained in subsection (b) of this Section for the treatment of stage 4 advanced, metastatic cancer.
(Source: P.A. 100-1057, eff. 1-1-19.)
 
    (Text of Section from P.A. 100-1065)
    Sec. 356z.29. Recovery housing for persons with substance use disorders.
    (a) Definitions. As used in this Section:
    "Substance use disorder" and "case management" have the meanings ascribed to those terms in Section 1-10 of the Substance Use Disorder Act.
    "Hospital" means a facility licensed by the Department of Public Health under the Hospital Licensing Act.
    "Federally qualified health center" means a facility as defined in Section 1905(l)(2)(B) of the federal Social Security Act.
    "Recovery housing" means a residential extended care treatment facility or a recovery home as defined and licensed in 77 Illinois Administrative Code, Part 2060, by the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery.
    (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 100th General Assembly may provide coverage for residential extended care services and supports for persons recovery housing for persons with substance use disorders who are at risk of a relapse following discharge from a health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department so long as all of the following conditions are met:
        (1) A health care clinic, federally qualified health
    
center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department has conducted an individualized assessment, using criteria established by the American Society of Addiction Medicine, of the person's condition prior to discharge and has identified the person as being at risk of a relapse and in need of supportive services, including employment and training and case management, to maintain long-term recovery. A determination of whether a person is in need of supportive services shall also be based on whether the person has a history of poverty, job insecurity, and lack of a safe and sober living environment.
        (2) The recovery housing is administered by a
    
community-based agency that is licensed by or under contract with the Department of Human Services, Division of Substance Use Prevention and Recovery.
        (3) The recovery housing is administered by a
    
community-based agency as described in paragraph (2) upon the referral of a health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department.
    (c) Based on the individualized needs assessment, any coverage provided in accordance with this Section may include, but not be limited to, the following:
        (1) Substance use disorder treatment services that
    
are in accordance with licensure standards promulgated by the Department of Human Services, Division of Substance Use Prevention and Recovery.
        (2) Transitional housing services, including food or
    
meal plans.
        (3) Individualized case management and referral
    
services, including case management and social services for the families of persons who are seeking treatment for a substance use disorder.
        (4) Job training or placement services.
    (d) The insurer may rate each community-based agency that is licensed by or under contract with the Department of Human Services, Division of Substance Use Prevention and Recovery to provide recovery housing based on an evaluation of each agency's ability to:
        (1) reduce health care costs;
        (2) reduce recidivism rates for persons suffering
    
from a substance use disorder;
        (3) improve outcomes;
        (4) track persons with substance use disorders; and
        (5) improve the quality of life of persons with
    
substance use disorders through the utilization of sustainable recovery, education, employment, and housing services.
    The insurer may publish the results of the ratings on its official website and shall, on an annual basis, update the posted results.
    (e) The Department of Insurance may adopt any rules necessary to implement the provisions of this Section in accordance with the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules; any purported rule not so adopted, for whatever reason, is unauthorized.
(Source: P.A. 100-1065, eff. 1-1-19.)
 
    (Text of Section from P.A. 100-1102)
    Sec. 356z.29. Coverage for fertility preservation services.
    (a) As used in this Section:
        "Iatrogenic infertility" means in impairment of
    
fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
        "May directly or indirectly cause" means the likely
    
possibility that treatment will cause a side effect of infertility, based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.
        "Standard fertility preservation services" means
    
procedures based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.
    (b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State after the effective date of this amendatory Act of the 100th General Assembly must provide coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee.
    (c) In determining coverage pursuant to this Section, an insurer shall not discriminate based on an individual's expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, or marital status.
    (d) If, at any time before or after the effective date of this amendatory Act of the 100th General Assembly, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for fertility preservation services, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for fertility preservation services.
(Source: P.A. 100-1102, eff. 1-1-19.)